Opportunities for further efficiencies exist. Trusts are clear that GIRFT, 'lean' working, better commercial practices, integration, and smarter use of technology can all play a part in ensuring the taxpayer pound is spent as wisely as possible. Better system working and addressing workforce challenges have also been identified by trust leaders as ways to achieve more significant efficiencies over the longer term.

However, our survey results demonstrate a low level of confidence that trusts can realise more savings, despite showing an overwhelming acknowledgement that there is still inefficiency in the wider NHS system.

Overall, trusts recognise their responsibility to plan for and then deliver a stretching efficiency ask within their trusts and local systems. Trust leaders believe that a stretching efficiency requirement is more likely to be delivered if:

  1. national system leaders, trusts and local systems work in partnership to agree a realistic efficiency requirement and timeframes for delivery rather than have these centrally imposed, top down, from the national system level
  2. national system leaders do more to help trusts and local systems identify and share learning from across the country about where efficiencies can be delivered
  3. national system leaders are realistic about the extra support that trusts and local systems will need to realise the transformational savings and local system focused savings that must now form the focus of efficiency and productivity activity
  4. any efficiency delivery assumptions explicitly match the capacity and capability available on the frontline given the ambitious list of other priorities trusts are expected to deliver

Better system working and addressing workforce challenges have been identified by trust leaders as ways to achieve more significant efficiencies over the longer term.



NHS Providers also recognises the role we can play in supporting trusts and we remain committed to working with the national bodies to help shape constructive offers of support from the centre, and to promote what works well as we have done with the GIRFT programme. We fully recognise our role in helping trusts share and showcase good practice.

The additional investment in the NHS and the forthcoming ten-year plan represent a rare opportunity to reset the operational pressure and endemic financial problems that are currently blighting the NHS. Increased efficiency is possible, but it should not be used as a financial balancing item reconciling a hugely ambitious improvement trajectory with a modest funding rise. Trusts must have access to the right mix of support and be given time and headroom to pursue long-term system efficiencies. If lessons are learned from the past, and the new settlement comes with a realistic efficiency target and a clear and robust delivery plan, it can succeed.